OMB control number

Certification Regarding Rights to Unemployment Benefits

OMB 3220-0079 · RRB.

OMB 3220-0079

In administering the disqualification for the voluntary leaving of work provision of Section 4 of the Railroad Unemployment Insurance Act, the Railroad Retirement Board investigates an unemployment claim that indicates the claimant left voluntarily. The certification obtains information needed to determine if the leaving was for good cause.

The latest form for Certification Regarding Rights to Unemployment Benefits expires 2026-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form UI-45 (11-16) Certification Regarding Rights to Unemployment Benefits Form
3220-0079 .docx Supporting Statement A
Form UI-1 (03-12).pdf Supplementary Document
Form UI-3 (02-09).pdf Supplementary Document
Chapter 315.pdf Supplementary Document
Form UI-33 (12-05).pdf Supplementary Document
Certification Regarding Rights to Unemployment Benefits Form

All Historical Document Collections

202308-3220-003 Approved without change	Extension without change of a currently approved collection	2023-09-05
202005-3220-001 Approved without change	Extension without change of a currently approved collection	2020-05-22
201702-3220-002 Approved without change	Extension without change of a currently approved collection	2017-03-10
201312-3220-001 Approved without change	Extension without change of a currently approved collection	2014-02-28
201011-3220-002 Approved without change	Extension without change of a currently approved collection	2010-11-29
200708-3220-002 Approved without change	Extension without change of a currently approved collection	2007-08-28
200407-3220-001 Approved without change	Revision of a currently approved collection	2004-07-06
200107-3220-001 Approved without change	Extension without change of a currently approved collection	2001-07-16
199806-3220-001 Approved without change	Revision of a currently approved collection	1998-06-24
199504-3220-001 Approved without change	Revision of a currently approved collection	1995-04-14
199202-3220-002 Approved without change	Revision of a currently approved collection	1992-02-13
198904-3220-012 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-10
198904-3220-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-03
198812-3220-002 Approved without change	Revision of a currently approved collection	1988-12-27
198802-3220-001 Approved without change	Extension without change of a currently approved collection	1988-02-02
198412-3220-002 Approved without change	Revision of a currently approved collection	1984-12-19
198111-3220-002 Approved without change	Extension without change of a currently approved collection	1981-11-17
198105-3220-017 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-05-28
198103-3220-033 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-03-21
198102-3220-011 Approved without change	Reinstatement with change of a previously approved collection	1981-02-19
197912-3220-004 Approved without change	Revision of a currently approved collection	1979-12-27
197410-3220-004 Approved without change	Extension without change of a currently approved collection	1974-10-29